Doctor Pundit

Apparently, POTUS wants it easier for hospitals that admit Medicare patients to make deals with physicians who see them there.

The goal is to open pathways for doctors and hospitals to work together to improve care and save money. The challenge will be to accomplish that without also increasing the risk of fraud. With its request for advice, the administration has touched off a lobbying frenzy.

No doubt there. Apparently, with his ongoing Twitter mentality and short attention span for anything policy wonkish, Trump has asked for recommendations regarding the easing of rules designed to eliminate fraud and kickbacks for physicians seeing these patients and the referral centers (and acute hospitals) that admit them. These rules are designed to prevent illegal payments between these entities which may influence each other.

Federal laws make it a crime to offer or pay any “remuneration” in return for the referral of Medicare or Medicaid patients, and they limit doctors’ ability to refer patients to medical businesses in which the doctors have a financial interest, known as self-referral.

These laws “impose undue burdens on physicians and serve as obstacles to ­coordinated care,” said Dr. James Madara, CEO of the American Medical Association. The laws, he said, were enacted decades ago “in a fee-for-service world that paid for services on a piecemeal basis.”

Melinda Hatton, senior vice president and general counsel of the American Hospital Association, said the laws stifle “many innocuous or beneficial arrangements” that could provide patients with better care at lower cost.

The problem is how one defines those “beneficial arrangements”, and do they rise to the level of fraud. The sudden interest of this administration in acute hospital Medicare and Medicaid policy should send a reg flag flying high for healthcare administrators, legal experts, and policy experts that any “review” of current anti-kickback statute is not only unnecessary, but potentially problematic.

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